August 2014 Case of the Month

A 48yo female presented with R sided flank pain for one day.  She also endorsed mild blood-tinged urine.  No fevers or chills. She reported a remote history of kidney stones, but hadn’t had one in years.  Her bedside ultrasound revealed the following:

hydro2 hydro3 hydro4

The patient has mild right sided hydronephrosis.  Her left kidney is normal.  In the bladder view, a hyperechoic stone with shadowing can be seen at the right UVJ.  The patient had a CT which confirmed the presence of a 2mm stone at the right UVJ, mild right sided hydronephrosis.    Her labs were normal with the exception of a mildly elevated calcium.

Bedside ultrasound is an excellent modality in the rapid evaluation of a patient who presents with symptoms concerning for renal colic.  Stones are not often visualized on ultrasound (as seen in the above clip).  The primary sonographic finding is hydronephrosis, and the degree of hydronephrosis correlates with the extent of obstruction, or the size of the stone.